Director, Payment Integrity Program Development

At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States.  And we've just started. So join us on this mission!

Job Description

A bit about this role:

At Devoted, we know that one of the most important ways we will build

trust with our network of providers and members is to pay claims

accurately and on time while having transparent payment policies. Our

Payment Integrity Department ensures that provider claims are paid

correctly by the responsible party, for eligible members, according to

contractual terms, not in error or duplicate, and free of wasteful or abusive

practices.

As a Payment Integrity Program Development Director, you will be

accountable for identifying and researching new medical cost savings

opportunities, developing short and long term solutions, and organizing

stakeholders to make “buy vs. build” decisions. You will assess new

opportunities by leveraging your subject matter expertise, researching

and evaluating CMS policies and industry trends, analyzing Devoted

claims performance, and collaborating internally with Finance, Medical

Economics, Network Management, Claims, and other experts and Senior

Leaders at Devoted.

Your Responsibilities and Impact will include:

• Identify, research, size, and develop new medical cost savings

• opportunities

• Leverage your subject matter expertise, policy research, industry trends, and internal and publicly available data to generate ideas

• Develop relationships and collaborate with internal stakeholders to collect ideas, align on goals, and develop solutions that bring most value while avoiding network disruption

• Use data and research to influence Senior Leadership to develop new strategies and policies

• Develop KPIs and reporting to track progress and provide transparency to Senior Leadership

• Collaborate with Operations and R&D to make “buy vs. build” decisions and oversee the process from ideation to development

• Build out and oversee the Payment Integrity Ideation Team

Required skills and experience:

• Bachelor's degree and a minimum of 6 years of relevant experience

• Understanding of US healthcare

• Knowledge of claims adjudication, revenue cycle management, and payment integrity

• Experience using data to inform ideation and strategy towards medical cost savings opportunities

• Proficiency in a variety of analytical and data mining tools to generate and analyze data sets

• Ability to collaborate, communicate, and influence horizontally and vertically

• Being comfortable in both leadership and execution roles

• Being comfortable with ambiguity and startup environment

• Ability to incorporate company vision, mission, and values in decision making

Desired skills and experience:

• Proficiency with SQL

• People management experience

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Salary Range: $164,000 - $228,000 / year

Our ranges are purposefully broad to allow for growth within the role over time. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered may depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• Employer sponsored health, dental and vision plan with low or no premium

• Generous paid time off

• $100 monthly mobile or internet stipend

• Stock options for all employees

• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles

• Parental leave program

• 401K program

• And more....

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Healthcare equality is at the center of Devoted’s mission to treat our members like family.  We are committed to a diverse and vibrant workforce. 

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.

Salary : $164,000 - $228,000